Provider Demographics
NPI:1033717558
Name:DISCOVER SMILES PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:DISCOVER SMILES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEERRAJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMASWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, MS, MPH
Authorized Official - Phone:517-281-3954
Mailing Address - Street 1:2277 SCIENCE PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2551
Mailing Address - Country:US
Mailing Address - Phone:517-574-4688
Mailing Address - Fax:
Practice Address - Street 1:2277 SCIENCE PKWY STE 2
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2551
Practice Address - Country:US
Practice Address - Phone:517-574-4688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114039146Medicaid